Apply Now AmeriCapital Direct Application AmeriCapital Direct Application If you are human, leave this field blank. Is your Entity a Corporation? Yes No Is your Entity an LLC? Yes No Is your Entity a Sole Proprietorship? Yes No State of Incorporation Federal Tax ID/BIN: Business Legal Name: DBA: Business Physical Address: City: State: Zip: Business Email: * If other business, list here: Business Established Date (mm/yy): Products/Services Sold: Total Monthly Sales Owner/Officer Name(1): Social Security No.(1): Date of Birth(1): Home Address (include Street, City, State/Zip): Title(1): Ownership %(1): Mobile Phone #(1): Email Address(1) What Type of Property? Owned Leased Monthly Lease/Mortgage Payment: Bank Name: Do you have an outstanding merchant cash advance(s) or short-term business loan(s)? Yes No If Yes, what is the company name(s) and current balance(s): Amount Requested: Intended Use of Funds: 1st Owner/Officer Signature: Date * Submit
